Comparison of Carbapenem-Resistant Microbial Pathogens in Combat and Non-combat Wounds of Military and Civilian Patients Seen at a Tertiary Military Hospital, Philippines (2013–2017)
Abstract Introduction Bacterial wound infections are a danger to both military and civilian populations. The nature of injury and infection associated with combat related wounds are important in guiding antibiotic prophylaxis and empiric treatment guidelines. Materials and Methods The isolates were...
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| Veröffentlicht in: | Military medicine 2020-02, Vol.185 (1-2), p.e197-e202 |
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| creator | Velasco, John Mark Valderama, Ma Theresa Margulieux, Katie Diones, Paula Corazon Peacock, Trent Navarro, Fatima Claire Liao, Cynthia Chua, Domingo Macareo, Louis Crawford, John Swierczewski, Brett |
| description | Abstract
Introduction
Bacterial wound infections are a danger to both military and civilian populations. The nature of injury and infection associated with combat related wounds are important in guiding antibiotic prophylaxis and empiric treatment guidelines.
Materials and Methods
The isolates were screened for drug-resistance by the MicroScan Walkaway Plus System using either the Negative Breakpoint Combo Panel (NBCP) 30 or 34 or Positive Breakpoint Combo Panel (PBPC) 20 or 23. Isolates with a minimum inhibitory concentration (MIC) of ≥8 μg/mL to imipenem and/or meropenem were tested for both carbapenemase production using the CarbaNP test and real-time PCR to determine molecular resistance mechanisms. Plasmid conjugation analysis was performed to define potential for horizontal gene transfer.
Results
We characterized 634 bacterial wound isolates collected from September 2013 to December 2017 from patients seen at a Philippine military tertiary hospital presenting with combat or non-combat injuries [354 (military) and 280 (civilians)]. Staphylococcus aureus was the most predominant bacterial species isolated from wounds in both populations (104/634, 16%). A variety of Gram-negative bacterial species comprised 442/634 (70%) of the isolates identified, with the most prevalent shown to be Pseudomonas aeruginosa, Enterobacter cloacae, Klebsiella pneumoniae, Escherichia coli, and Acinetobacter sp. Carbapenemase production was detected in 34/442 (8%) Gram-negative isolates. Testing for molecular resistance mechanisms showed 32/34 (17 military, 15 civilian) wound isolates were blaNDM positive and 2 were blaVIM positive, with the two blaVIM isolates found in the civilian population. Plasmid conjugation of 14 blaNDM and 2 blaVIM positive wound isolates representatives showed 2/16 (13%) produced E. coli J53 transconjugants (E. coli from a civilian; E. cloacae from a military).
Conclusion
We describe in this study the wound bacterial and antibiotic resistance profile in the military (combat vs non-combat associated) and civilian population. We observed that, with the exception of Acinetobacter sp., resistance of prevalent Gram-negative bacterial species to imipenem or meropenem were not significantly different between the military and civilian populations. We also presented data on the prevalent bacterial species isolated from both combat and non-combat wounds in a military tertiary care hospital setting as well as the carbapenemase-encoding gene primarily responsib |
| doi_str_mv | 10.1093/milmed/usz148 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2250647651</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1093/milmed/usz148</oup_id><sourcerecordid>2430102479</sourcerecordid><originalsourceid>FETCH-LOGICAL-c393t-e15f450b84c019b0cc8a4a35180c5d33f254007f11c89a4e3c19ab8e48d6e7023</originalsourceid><addsrcrecordid>eNqFkU1u1zAQxS0Eon8KS7bIEpsiETqO7XwsUQS0UgsVFMEucpwJdZXYwXaQYMUduAzn6UlwSAsSG1bjGf3e03geIQ8ZPGNQ88PJjBP2h0v4xkR1i-xYzSErGP94m-wA8iITUMo9ci-ESwAm6ordJXuc5aKESu7Iz8ZNs_ImOEvdQBvlOzWjxSl7i8GEqGykp0Z71xk10jMVL9wntIEaS5OyU5Eq29PXzmZ6az-4xfZh9To1o4nKf_1NNOZLapVdLQzaGOg7REtXPT1HH80K_lEcuTCn1_iUnl2k2Twbi4Ee5MD41fcfqZRP7pM7gxoDPriu--T9yxfnzVF28ubVcfP8JNO85jFDJgchoauEBlZ3oHWlhOKSVaBlz_mQSwFQDozpqlYCuWa16ioUVV9gCTnfJweb7-zd5wVDbCcTNI6jsuiW0Oa5hEKUhWQJffwPeukWb9N2bS44MEhHrxOVbVQ6aggeh3b2Zkq_bhm0a6TtFmm7RZr4R9euS7eOb-ibDP9u6Jb5P16_ALW7rdw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2430102479</pqid></control><display><type>article</type><title>Comparison of Carbapenem-Resistant Microbial Pathogens in Combat and Non-combat Wounds of Military and Civilian Patients Seen at a Tertiary Military Hospital, Philippines (2013–2017)</title><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Oxford University Press Journals All Titles (1996-Current)</source><creator>Velasco, John Mark ; Valderama, Ma Theresa ; Margulieux, Katie ; Diones, Paula Corazon ; Peacock, Trent ; Navarro, Fatima Claire ; Liao, Cynthia ; Chua, Domingo ; Macareo, Louis ; Crawford, John ; Swierczewski, Brett</creator><creatorcontrib>Velasco, John Mark ; Valderama, Ma Theresa ; Margulieux, Katie ; Diones, Paula Corazon ; Peacock, Trent ; Navarro, Fatima Claire ; Liao, Cynthia ; Chua, Domingo ; Macareo, Louis ; Crawford, John ; Swierczewski, Brett</creatorcontrib><description>Abstract
Introduction
Bacterial wound infections are a danger to both military and civilian populations. The nature of injury and infection associated with combat related wounds are important in guiding antibiotic prophylaxis and empiric treatment guidelines.
Materials and Methods
The isolates were screened for drug-resistance by the MicroScan Walkaway Plus System using either the Negative Breakpoint Combo Panel (NBCP) 30 or 34 or Positive Breakpoint Combo Panel (PBPC) 20 or 23. Isolates with a minimum inhibitory concentration (MIC) of ≥8 μg/mL to imipenem and/or meropenem were tested for both carbapenemase production using the CarbaNP test and real-time PCR to determine molecular resistance mechanisms. Plasmid conjugation analysis was performed to define potential for horizontal gene transfer.
Results
We characterized 634 bacterial wound isolates collected from September 2013 to December 2017 from patients seen at a Philippine military tertiary hospital presenting with combat or non-combat injuries [354 (military) and 280 (civilians)]. Staphylococcus aureus was the most predominant bacterial species isolated from wounds in both populations (104/634, 16%). A variety of Gram-negative bacterial species comprised 442/634 (70%) of the isolates identified, with the most prevalent shown to be Pseudomonas aeruginosa, Enterobacter cloacae, Klebsiella pneumoniae, Escherichia coli, and Acinetobacter sp. Carbapenemase production was detected in 34/442 (8%) Gram-negative isolates. Testing for molecular resistance mechanisms showed 32/34 (17 military, 15 civilian) wound isolates were blaNDM positive and 2 were blaVIM positive, with the two blaVIM isolates found in the civilian population. Plasmid conjugation of 14 blaNDM and 2 blaVIM positive wound isolates representatives showed 2/16 (13%) produced E. coli J53 transconjugants (E. coli from a civilian; E. cloacae from a military).
Conclusion
We describe in this study the wound bacterial and antibiotic resistance profile in the military (combat vs non-combat associated) and civilian population. We observed that, with the exception of Acinetobacter sp., resistance of prevalent Gram-negative bacterial species to imipenem or meropenem were not significantly different between the military and civilian populations. We also presented data on the prevalent bacterial species isolated from both combat and non-combat wounds in a military tertiary care hospital setting as well as the carbapenemase-encoding gene primarily responsible for carbapenem resistance as well as evidence of horizontal transfer via mobile genetic elements. Clinicians may use this information to guide empiric antibiotic coverage for the predominant organisms if wound culture results are not readily available.
A prospective, longitudinal evaluation of the wound bacterial profile documenting the changing bacterial flora using higher resolution molecular strategies can provide a more comprehensive understanding of the diversity, composition, and abundance of bacterial composition of the wound microbial community from the time of injury, during the course of evacuation from the field to higher level of care facilities, and up to wound resolution.</description><identifier>ISSN: 0026-4075</identifier><identifier>EISSN: 1930-613X</identifier><identifier>DOI: 10.1093/milmed/usz148</identifier><identifier>PMID: 31247085</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Anti-Bacterial Agents - pharmacology ; Anti-Bacterial Agents - therapeutic use ; Antibiotics ; Carbapenems ; E coli ; Escherichia coli - genetics ; Hospitals, Military ; Humans ; Microbial Sensitivity Tests ; Military Personnel ; Philippines - epidemiology ; Prospective Studies ; Tertiary Care Centers ; United States</subject><ispartof>Military medicine, 2020-02, Vol.185 (1-2), p.e197-e202</ispartof><rights>Association of Military Surgeons of the United States 2019. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com 2019</rights><rights>Association of Military Surgeons of the United States 2019. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.</rights><rights>Association of Military Surgeons of the United States 2019. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c393t-e15f450b84c019b0cc8a4a35180c5d33f254007f11c89a4e3c19ab8e48d6e7023</citedby><cites>FETCH-LOGICAL-c393t-e15f450b84c019b0cc8a4a35180c5d33f254007f11c89a4e3c19ab8e48d6e7023</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,1584,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31247085$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Velasco, John Mark</creatorcontrib><creatorcontrib>Valderama, Ma Theresa</creatorcontrib><creatorcontrib>Margulieux, Katie</creatorcontrib><creatorcontrib>Diones, Paula Corazon</creatorcontrib><creatorcontrib>Peacock, Trent</creatorcontrib><creatorcontrib>Navarro, Fatima Claire</creatorcontrib><creatorcontrib>Liao, Cynthia</creatorcontrib><creatorcontrib>Chua, Domingo</creatorcontrib><creatorcontrib>Macareo, Louis</creatorcontrib><creatorcontrib>Crawford, John</creatorcontrib><creatorcontrib>Swierczewski, Brett</creatorcontrib><title>Comparison of Carbapenem-Resistant Microbial Pathogens in Combat and Non-combat Wounds of Military and Civilian Patients Seen at a Tertiary Military Hospital, Philippines (2013–2017)</title><title>Military medicine</title><addtitle>Mil Med</addtitle><description>Abstract
Introduction
Bacterial wound infections are a danger to both military and civilian populations. The nature of injury and infection associated with combat related wounds are important in guiding antibiotic prophylaxis and empiric treatment guidelines.
Materials and Methods
The isolates were screened for drug-resistance by the MicroScan Walkaway Plus System using either the Negative Breakpoint Combo Panel (NBCP) 30 or 34 or Positive Breakpoint Combo Panel (PBPC) 20 or 23. Isolates with a minimum inhibitory concentration (MIC) of ≥8 μg/mL to imipenem and/or meropenem were tested for both carbapenemase production using the CarbaNP test and real-time PCR to determine molecular resistance mechanisms. Plasmid conjugation analysis was performed to define potential for horizontal gene transfer.
Results
We characterized 634 bacterial wound isolates collected from September 2013 to December 2017 from patients seen at a Philippine military tertiary hospital presenting with combat or non-combat injuries [354 (military) and 280 (civilians)]. Staphylococcus aureus was the most predominant bacterial species isolated from wounds in both populations (104/634, 16%). A variety of Gram-negative bacterial species comprised 442/634 (70%) of the isolates identified, with the most prevalent shown to be Pseudomonas aeruginosa, Enterobacter cloacae, Klebsiella pneumoniae, Escherichia coli, and Acinetobacter sp. Carbapenemase production was detected in 34/442 (8%) Gram-negative isolates. Testing for molecular resistance mechanisms showed 32/34 (17 military, 15 civilian) wound isolates were blaNDM positive and 2 were blaVIM positive, with the two blaVIM isolates found in the civilian population. Plasmid conjugation of 14 blaNDM and 2 blaVIM positive wound isolates representatives showed 2/16 (13%) produced E. coli J53 transconjugants (E. coli from a civilian; E. cloacae from a military).
Conclusion
We describe in this study the wound bacterial and antibiotic resistance profile in the military (combat vs non-combat associated) and civilian population. We observed that, with the exception of Acinetobacter sp., resistance of prevalent Gram-negative bacterial species to imipenem or meropenem were not significantly different between the military and civilian populations. We also presented data on the prevalent bacterial species isolated from both combat and non-combat wounds in a military tertiary care hospital setting as well as the carbapenemase-encoding gene primarily responsible for carbapenem resistance as well as evidence of horizontal transfer via mobile genetic elements. Clinicians may use this information to guide empiric antibiotic coverage for the predominant organisms if wound culture results are not readily available.
A prospective, longitudinal evaluation of the wound bacterial profile documenting the changing bacterial flora using higher resolution molecular strategies can provide a more comprehensive understanding of the diversity, composition, and abundance of bacterial composition of the wound microbial community from the time of injury, during the course of evacuation from the field to higher level of care facilities, and up to wound resolution.</description><subject>Anti-Bacterial Agents - pharmacology</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Antibiotics</subject><subject>Carbapenems</subject><subject>E coli</subject><subject>Escherichia coli - genetics</subject><subject>Hospitals, Military</subject><subject>Humans</subject><subject>Microbial Sensitivity Tests</subject><subject>Military Personnel</subject><subject>Philippines - epidemiology</subject><subject>Prospective Studies</subject><subject>Tertiary Care Centers</subject><subject>United States</subject><issn>0026-4075</issn><issn>1930-613X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkU1u1zAQxS0Eon8KS7bIEpsiETqO7XwsUQS0UgsVFMEucpwJdZXYwXaQYMUduAzn6UlwSAsSG1bjGf3e03geIQ8ZPGNQ88PJjBP2h0v4xkR1i-xYzSErGP94m-wA8iITUMo9ci-ESwAm6ordJXuc5aKESu7Iz8ZNs_ImOEvdQBvlOzWjxSl7i8GEqGykp0Z71xk10jMVL9wntIEaS5OyU5Eq29PXzmZ6az-4xfZh9To1o4nKf_1NNOZLapVdLQzaGOg7REtXPT1HH80K_lEcuTCn1_iUnl2k2Twbi4Ee5MD41fcfqZRP7pM7gxoDPriu--T9yxfnzVF28ubVcfP8JNO85jFDJgchoauEBlZ3oHWlhOKSVaBlz_mQSwFQDozpqlYCuWa16ioUVV9gCTnfJweb7-zd5wVDbCcTNI6jsuiW0Oa5hEKUhWQJffwPeukWb9N2bS44MEhHrxOVbVQ6aggeh3b2Zkq_bhm0a6TtFmm7RZr4R9euS7eOb-ibDP9u6Jb5P16_ALW7rdw</recordid><startdate>20200212</startdate><enddate>20200212</enddate><creator>Velasco, John Mark</creator><creator>Valderama, Ma Theresa</creator><creator>Margulieux, Katie</creator><creator>Diones, Paula Corazon</creator><creator>Peacock, Trent</creator><creator>Navarro, Fatima Claire</creator><creator>Liao, Cynthia</creator><creator>Chua, Domingo</creator><creator>Macareo, Louis</creator><creator>Crawford, John</creator><creator>Swierczewski, Brett</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>4T-</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>20200212</creationdate><title>Comparison of Carbapenem-Resistant Microbial Pathogens in Combat and Non-combat Wounds of Military and Civilian Patients Seen at a Tertiary Military Hospital, Philippines (2013–2017)</title><author>Velasco, John Mark ; Valderama, Ma Theresa ; Margulieux, Katie ; Diones, Paula Corazon ; Peacock, Trent ; Navarro, Fatima Claire ; Liao, Cynthia ; Chua, Domingo ; Macareo, Louis ; Crawford, John ; Swierczewski, Brett</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c393t-e15f450b84c019b0cc8a4a35180c5d33f254007f11c89a4e3c19ab8e48d6e7023</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Anti-Bacterial Agents - pharmacology</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Antibiotics</topic><topic>Carbapenems</topic><topic>E coli</topic><topic>Escherichia coli - genetics</topic><topic>Hospitals, Military</topic><topic>Humans</topic><topic>Microbial Sensitivity Tests</topic><topic>Military Personnel</topic><topic>Philippines - epidemiology</topic><topic>Prospective Studies</topic><topic>Tertiary Care Centers</topic><topic>United States</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Velasco, John Mark</creatorcontrib><creatorcontrib>Valderama, Ma Theresa</creatorcontrib><creatorcontrib>Margulieux, Katie</creatorcontrib><creatorcontrib>Diones, Paula Corazon</creatorcontrib><creatorcontrib>Peacock, Trent</creatorcontrib><creatorcontrib>Navarro, Fatima Claire</creatorcontrib><creatorcontrib>Liao, Cynthia</creatorcontrib><creatorcontrib>Chua, Domingo</creatorcontrib><creatorcontrib>Macareo, Louis</creatorcontrib><creatorcontrib>Crawford, John</creatorcontrib><creatorcontrib>Swierczewski, Brett</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Docstoc</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Military medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Velasco, John Mark</au><au>Valderama, Ma Theresa</au><au>Margulieux, Katie</au><au>Diones, Paula Corazon</au><au>Peacock, Trent</au><au>Navarro, Fatima Claire</au><au>Liao, Cynthia</au><au>Chua, Domingo</au><au>Macareo, Louis</au><au>Crawford, John</au><au>Swierczewski, Brett</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparison of Carbapenem-Resistant Microbial Pathogens in Combat and Non-combat Wounds of Military and Civilian Patients Seen at a Tertiary Military Hospital, Philippines (2013–2017)</atitle><jtitle>Military medicine</jtitle><addtitle>Mil Med</addtitle><date>2020-02-12</date><risdate>2020</risdate><volume>185</volume><issue>1-2</issue><spage>e197</spage><epage>e202</epage><pages>e197-e202</pages><issn>0026-4075</issn><eissn>1930-613X</eissn><abstract>Abstract
Introduction
Bacterial wound infections are a danger to both military and civilian populations. The nature of injury and infection associated with combat related wounds are important in guiding antibiotic prophylaxis and empiric treatment guidelines.
Materials and Methods
The isolates were screened for drug-resistance by the MicroScan Walkaway Plus System using either the Negative Breakpoint Combo Panel (NBCP) 30 or 34 or Positive Breakpoint Combo Panel (PBPC) 20 or 23. Isolates with a minimum inhibitory concentration (MIC) of ≥8 μg/mL to imipenem and/or meropenem were tested for both carbapenemase production using the CarbaNP test and real-time PCR to determine molecular resistance mechanisms. Plasmid conjugation analysis was performed to define potential for horizontal gene transfer.
Results
We characterized 634 bacterial wound isolates collected from September 2013 to December 2017 from patients seen at a Philippine military tertiary hospital presenting with combat or non-combat injuries [354 (military) and 280 (civilians)]. Staphylococcus aureus was the most predominant bacterial species isolated from wounds in both populations (104/634, 16%). A variety of Gram-negative bacterial species comprised 442/634 (70%) of the isolates identified, with the most prevalent shown to be Pseudomonas aeruginosa, Enterobacter cloacae, Klebsiella pneumoniae, Escherichia coli, and Acinetobacter sp. Carbapenemase production was detected in 34/442 (8%) Gram-negative isolates. Testing for molecular resistance mechanisms showed 32/34 (17 military, 15 civilian) wound isolates were blaNDM positive and 2 were blaVIM positive, with the two blaVIM isolates found in the civilian population. Plasmid conjugation of 14 blaNDM and 2 blaVIM positive wound isolates representatives showed 2/16 (13%) produced E. coli J53 transconjugants (E. coli from a civilian; E. cloacae from a military).
Conclusion
We describe in this study the wound bacterial and antibiotic resistance profile in the military (combat vs non-combat associated) and civilian population. We observed that, with the exception of Acinetobacter sp., resistance of prevalent Gram-negative bacterial species to imipenem or meropenem were not significantly different between the military and civilian populations. We also presented data on the prevalent bacterial species isolated from both combat and non-combat wounds in a military tertiary care hospital setting as well as the carbapenemase-encoding gene primarily responsible for carbapenem resistance as well as evidence of horizontal transfer via mobile genetic elements. Clinicians may use this information to guide empiric antibiotic coverage for the predominant organisms if wound culture results are not readily available.
A prospective, longitudinal evaluation of the wound bacterial profile documenting the changing bacterial flora using higher resolution molecular strategies can provide a more comprehensive understanding of the diversity, composition, and abundance of bacterial composition of the wound microbial community from the time of injury, during the course of evacuation from the field to higher level of care facilities, and up to wound resolution.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>31247085</pmid><doi>10.1093/milmed/usz148</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Anti-Bacterial Agents - pharmacology Anti-Bacterial Agents - therapeutic use Antibiotics Carbapenems E coli Escherichia coli - genetics Hospitals, Military Humans Microbial Sensitivity Tests Military Personnel Philippines - epidemiology Prospective Studies Tertiary Care Centers United States |
| title | Comparison of Carbapenem-Resistant Microbial Pathogens in Combat and Non-combat Wounds of Military and Civilian Patients Seen at a Tertiary Military Hospital, Philippines (2013–2017) |
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